Does anyone out there state in their SOP's about an alternative to AB patients when giving FFP. This would be in an emergency situation when we are out of AB FFP and our supplier is also. Do you state the ability to give alternate types when you have started to switch the type for packed cells?

Our statement would be to call in the medical director and have them interface with the phyisican. Any other type would be incompatible as I am sure you are aware. If a coagulation problem is the reason for giving, perhaps CRYO would be an alternative product. It would be our recommendation NOT to give any FFP under those circumstances if at all avoidable. Alternate types for packed cells are per AABB guidelines, except in the case of RH pos to RH neg. That has a deviation from SOP log and a medical director consult.

I believe there is a chart in the Tech Manaul for giving non-group specific plasma, based on isoagglutinin titration studies in donors. It's listed in my SOP for those situations you describe.

I vaguely remember -- and I "vaguely remember" just about everything nowadays -- that the Anti-B in group A donors is usually less than the Anti-A in group B donors, with group O plasma as your last resort.

We set a maximum "incompatible" plasma that can be transfused without getting the Medical Director involved.

Depending on the "why" for the FP, there are also factor/activated factor concentrates that are available (from the pHarmacy), esp if you are only giving plasma to ameliorate anticoagulation.

We have an incompatible plasma protocol that is most often used with platelets but would come into play for FFP if needed.

:surrenderI find it interesting that "we" don't seem to blink an eye when giving incompatible plasma in the form of platelets but giving an equal volume of incompatible FFP causes a great amount of anxiety.

How true, John! Until a few months ago when I redid the dictionary, our computer would allow incompatible platelets, but not incompatible FFP.

I don't recall a published study concluding that the isoagglutinin titers in apheresis donors are less than the titers in whole blood donors

Our policy allows use of Group A FFP for AB or B patients in "Massive Transfusion Situations" (greater than 10 units RBCs in 2-3 hours). We are 2 hours from our blood supplier and could not keep enough inventory of AB plasma (or B infact) on hand to handle a truly massive bleed. (Plus, we'll run out of AB or B red cells pretty quickly in this situation and switch to A or O.)

Luckily, we have never had to do this.

Linda Frederick

Well when you think about the amount of plasma in the platelets and the amount in FFP, it kind of puts things in perspective doesn't it? Our policy defines guidelines for giving RH pos platelets to RH neg patients of childbearing age, because Anti-D is such a problem, even in small amounts. Type specific platelets are used here for cancer patients who have a wrecked immune system anyway.